Communication and Compassion Are Essential To Improving Maternal Health Outcomes
How Dr. Sharmila Makhija is improving maternal health in the Bronx.
Women who deliver babies in the Bronx, New York face socio-economic and healthcare challenges that make it among the most high-risk places to give birth in America. We asked Sharmila Makhija, MD, M.B.A, OB/GYN, Department Chair of Obstetrics & Gynecology and Women’s Health at Albert Einstein College of Medicine and Montefiore Health System in the Bronx, NY how she’s working to turn around the most daunting maternal health statistics in the U.S.
EMC: Dr. Makhija, how bad is the maternal health situation in the Bronx?
Dr. Makhija: Our maternal mortality rate in the Bronx ranges from 26 to 32 deaths per 100,000 births, whereas the U.S. rate averages 14 deaths per 100,000. While we’re making technological advancements that affect medical care, it’s the basic elements of delivering care that are needed and often overlooked in making a real impact on outcomes. Maternal health is one of the areas that needs better focus on delivering coordinated care that positively impacts women’s health.
EMC: What changes are you implementing as the new head of the OB department?
Dr. Makhija: We’re reviewing how labor and delivery units are organized and creating better workflow environments for patients, nurses, providers and our entire team. Our focus is on improving training and communication techniques between team members as well as providing quality clinical care that centers on compassion. We conduct simulation training labs where everyone on the team — nurses, anesthesiologists, midwives, physician assistants and doctors — practices specific emergency situations. We drill on who does what and more importantly how to communicate effectively. Then we audit how care is delivered and retrain when we need to.
EMC: Tell me more about the communication aspect of this training.
Dr. Makhija: During training, we run through before and after scenarios that exemplify good and bad communication. We use real examples like when a nurse needs a doctor to come see a patient she thinks needs attention. We address common conflicts like a nurse who doesn’t give enough details or a doctor who is dismissive. After we run these drills, our team members often say, “I didn’t realize I came across that way.” Communication in stressful medical situations is complicated. If we improve communication skills, we’ll improve our patients’ healthcare experiences and outcomes.
EMC: How big a challenge is the authority dynamic between nurses and providers?
Dr. Makhija: It can be a problem and it must change. We need to support all team members to be able to speak up and question anyone, including the doctors, when they feel they haven’t been heard or received an adequate response. I personally realized that even though I learned medicine in medical school, what the nurses taught me was invaluable. I learned from them how to take care of and communicate with patients. Everyone on the team is essential in providing care to our patients. There are so many personalities and experiences on every team. From the resident trying to establish their authority, to the nurses who feel they aren’t empowered to question a doctor, to the senior attending doctor who is set in their opinions. It’s hard enough to take care of a patient who is quickly getting sick. We can’t afford to let poor communication and our egos get in the way.
EMC: Are you seeing improvement?
Dr. Makhija: We’re moving in the right direction. There are so many different layers of communication. For example, our case reviews have revealed that the fear of blaming has resulted in team members not communicating directly with each other. When we’ve had an unfavorable outcome, we find that there wasn’t any issue with the quality of care delivered. But we realized there was discomfort with how we talked to each other during patient care. Now, we’re focused on making it more comfortable so we can center our attention on the actual delivery of complex care. This is what I call the “art of medicine,” which is often overlooked in this era of “technology focused” medicine.
EMC: Is it difficult to get hospital systems to support these kinds of approaches?
Dr. Makhija: Montefiore has been on the forefront in understanding and valuing this approach as our mission has been on population health and providing better outcomes for our community. Our maternal mortality rate is the highest in the country and our goal is to improve this. It isn’t about making money. It’s about providing the best healthcare we can to our community of patients.
EMC: How do we make maternal healthcare more patient and woman-centered?
Dr. Makhija: We need improve how we ask our patients what they need. Ask if there’s something you can do for them or their family member. Ask if they have questions. Most of the time they’ll say, “ No, I’m fine,” but by asking, you’re acknowledging that they’re a part of the team. They’re the reason we’re here. We don’t have to be complicated about it. They want to know you care. I want everyone to know that we’re focused on delivering the best quality care and treating our patients like family. Funny thing though, I once told a patient, “I’m going to take care of you like you’re my mom.” She hesitated and then asked, “I hope you like your mom.” She was relieved when I said, “yes.” Now I tell my patients, “ I will take care of you like you’re my family and I happen to love my family.”